Infection

, Volume 41, Issue 5, pp 903–907 | Cite as

Toxicity and adherence to treatment for latent tuberculosis infection in patients with hematologic malignancies

  • E. M. Sánchez-García
  • R. Gamallo
  • A. Blanco-Moure
  • M. A. Viejo
  • L. Amador
  • L. Anibarro
Clinical and Epidemiological Study

Abstract

Purpose

Oncohematological patients undergoing chemotherapy who have latent tuberculosis infection (LTBI) are at a high risk of developing active tuberculosis (TB). The identification and treatment of these patients can prevent LTBI progressing to active TB. This study analyzed the degree of adherence with and safety of the treatment of latent tuberculosis infection (TLTBI) in oncohematological patients undergoing antineoplastic chemotherapy.

Methods

This is a retrospective study of a cohort of oncohematological patients receiving TLTBI and antineoplastic chemotherapy simultaneously, between January 2007 and June 2010. The proportions of toxicity and adherence to TLTBI in these patients were compared with a non-oncohematological control group, matched for age, sex, and year in which the TLTBI was started. In addition, a minimum 2-year follow-up was carried out for all patients.

Results

A total of 105 patients who received TLTBI were included, 21 of whom had received antineoplastic chemotherapy simultaneously. The mean age of the patients was 63 years. There were no significant baseline differences in transaminase values. The percentages of patients completing treatment were 76.2 % in the control group and 71.4 % in the oncohematological group [risk ratio (RR): 1.07, 95 % confidence interval (CI): 0.79–1.43]. The voluntary dropout proportion was similar in both groups (12.3 vs. 11.8 %, RR: 1.05, 95 % CI: 0.25–4.42). Treatment was discontinued because of toxicity in three oncohematological patients and in 11 patients from the control group (RR: 1.14; 95 % CI: 035–3.66). No patient developed TB during the follow-up period.

Conclusion

The safety of TLTBI is not influenced by simultaneous antineoplastic chemotherapy in oncohematological patients.

Keywords

Tuberculosis Latent tuberculosis Hematologic neoplasms Adherence Drug toxicity 

Notes

Acknowledgments

We acknowledge the European Union Seventh Framework Programme (FP7/REGPOT-2012-2013.1) under grant agreement BIOCAPS-316265.

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

References

  1. 1.
    Stefan DC, Kruis AL, Schaaf HS, Wessels G. Tuberculosis in oncology patients. Ann Trop Paediatr. 2008;28:111–6.PubMedCrossRefGoogle Scholar
  2. 2.
    Kaplan MH, Armstrong D, Rosen P. Tuberculosis complicating neoplastic disease. A review of 201 cases. Cancer. 1974;33:850–8.PubMedCrossRefGoogle Scholar
  3. 3.
    Wu CY, Hu HY, Pu CY, et al. Aerodigestive tract, lung and haematological cancers are risk factors for tuberculosis: an 8-year population-based study. Int J Tuberc Lung Dis. 2011;15:125–30.PubMedGoogle Scholar
  4. 4.
    Kamboj M, Sepkowitz KA. The risk of tuberculosis in patients with cancer. Clin Infect Dis. 2006;42:1592–5.PubMedCrossRefGoogle Scholar
  5. 5.
    Chen CY, Sheng WH, Cheng A, et al. Clinical characteristics and outcomes of Mycobacterium tuberculosis disease in adult patients with hematological malignancies. BMC Infect Dis. 2011;11:324.PubMedCrossRefGoogle Scholar
  6. 6.
    Silva FA, Matos JO, de Q Mello FC, Nucci M. Risk factors for and attributable mortality from tuberculosis in patients with hematologic malignances. Haematologica. 2005;90:1110–5.PubMedGoogle Scholar
  7. 7.
    Falagas ME, Kouranos VD, Athanassa Z, Kopterides P. Tuberculosis and malignancy. QJM. 2010;103:461–87.PubMedCrossRefGoogle Scholar
  8. 8.
    De La Rosa GR, Jacobson KL, Rolston KV, Raad II, Kontoyiannis DP, Safdar A. Mycobacterium tuberculosis at a comprehensive cancer centre: active disease in patients with underlying malignancy during 1990–2000. Clin Microbiol Infect. 2004;10:749–52.CrossRefGoogle Scholar
  9. 9.
    Jasmer RM, Nahid P, Hopewell PC. Clinical practice. Latent tuberculosis infection. N Engl J Med. 2002;347:1860–6.PubMedCrossRefGoogle Scholar
  10. 10.
    González-Martín J, García-García JM, Anibarro L, et al. Consensus document on the diagnosis, treatment and prevention of tuberculosis. Enferm Infecc Microbiol Clin. 2010;28:297.e1–20.CrossRefGoogle Scholar
  11. 11.
    Carvalho AC, Schumacher RF, Bigoni S, et al. Contact investigation based on serial interferon-gamma release assays (IGRA) in children from the hematology–oncology ward after exposure to a patient with pulmonary tuberculosis. Infection. 2013 (Epub ahead of print). doi: 10.1007/s15010-013-0450-y.
  12. 12.
    [No authors listed]. Targeted tuberculin testing and treatment of latent tuberculosis infection. American Thoracic Society. MMWR Recomm Rep. 2000;49:1–51.Google Scholar
  13. 13.
    Treatment for latent tuberculosis infection. Core curriculum on tuberculosis: what the clinician should know. Centers for Disease Control and Prevention. National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Division of Tuberculosis Elimination. 2011. p. 109–37. http://www.cdc.gov/tb/education/corecurr/pdf/chapter5.pdf
  14. 14.
    Migliori GB, Zellweger JP, Abubakar I, et al. European union standards for tuberculosis care. Eur Respir J. 2012;39:807–19.PubMedCrossRefGoogle Scholar
  15. 15.
    Anibarro L, Casas S, Paz-Esquete J, et al. Treatment completion in latent tuberculosis infection at specialist tuberculosis units in Spain. Int J Tuberc Lung Dis. 2010;14:701–7.PubMedGoogle Scholar
  16. 16.
    Cardona PJ. A dynamic reinfection hypothesis of latent tuberculosis infection. Infection. 2009;37:80–6.PubMedCrossRefGoogle Scholar
  17. 17.
    Libshitz HI, Pannu HK, Elting LS, Cooksley CD. Tuberculosis in cancer patients: an update. J Thorac Imaging. 1997;12:41–6.PubMedCrossRefGoogle Scholar
  18. 18.
    Chen CY, Sheng WH, Lai CC, et al. Mycobacterial infections in adult patients with hematological malignancy. Eur J Clin Microbiol Infect Dis. 2012;31:1059–66.PubMedCrossRefGoogle Scholar
  19. 19.
    Pizzo PA. Fever in immunocompromised patients. N Engl J Med. 1999;341:893–900.PubMedCrossRefGoogle Scholar
  20. 20.
    Sterling TR, Villarino ME, Borisov AS, et al. Three months of rifapentine and isoniazid for latent tuberculosis infection. N Engl J Med. 2011;365:2155–66.PubMedCrossRefGoogle Scholar
  21. 21.
    Kwara A, Herold JS, Machan JT, Carter EJ. Factors associated with failure to complete isoniazid treatment for latent tuberculosis infection in Rhode Island. Chest. 2008;133:862–8.PubMedCrossRefGoogle Scholar
  22. 22.
    Kunst H, Khan KS. Age-related risk of hepatotoxicity in the treatment of latent tuberculosis infection: a systematic review. Int J Tuberc Lung Dis. 2010;14:1374–81.PubMedGoogle Scholar
  23. 23.
    Santín Cerezales M, Benítez JD. Diagnosis of tuberculosis infection using interferon-gamma-based assays. Enferm Infecc Microbiol Clin. 2011;29:26–33.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • E. M. Sánchez-García
    • 1
  • R. Gamallo
    • 1
  • A. Blanco-Moure
    • 1
  • M. A. Viejo
    • 1
  • L. Amador
    • 3
  • L. Anibarro
    • 1
    • 2
  1. 1.Servicio de Medicina Interna, Unidad de TuberculosisComplexo Hospitalario de PontevedraPontevedraSpain
  2. 2.Instituto de Investigación Biomédica de Vigo (IBIV)VigoSpain
  3. 3.Servicio de HematologíaComplexo Hospitalario de PontevedraPontevedraSpain

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